A Case Report of Acute Necrotizing Encephalitis

Khalilalrahman Alshantti,Mitchell Modi Mijol,Chandran Nadarajan

doi:10.7759/cureus.21100

Khalilalrahman Alshantti, Mitchell Modi Mijol + Show 1 more

Open Access

https://doi.org/10.7759/cureus.21100

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Journal: Cureus	Publication Date: Jan 11, 2022
License type: cc-by

Affiliation: Hospital Universiti Sains Malaysia

Abstract

Acute necrotizing encephalitis (ANEC) is a rare entity seen primarily in East Asian infants and previously healthy children. A 5-year-old boy complained of fever and seizures, which developed into status epilepticus. Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) brains showed acute necrotizing encephalitis features. Empirical treatment for meningoencephalitis with supportive therapy was administered. MRI was then repeated 25 days post-therapy, which showed the previously seen abnormal signal intensities resolution. The patient was subsequently discharged home with moderate neurological impairment. Although ANEC is a rare disease, a typical clinical scenario and MRI findings should prompt recognition of the disease, essential for treatment.

Highlights

Acute necrotizing encephalopathy (ANEC) is an atypical encephalopathy seen only in previously healthy infants and children
The acute necrotizing encephalopathy of childhood is rare, with over 110 cases reported in the literature [6]
No specific changes are seen in the laboratory tests in the patient with ANEC, except for a rise in cerebrospinal fluid (CSF) protein without pleocytosis and elevated liver enzymes [3]

Summary

Introduction

Acute necrotizing encephalopathy (ANEC) is an atypical encephalopathy seen only in previously healthy infants and children. Mycoplasma, herpes simplex virus, human herpesvirus-6, and influenza virus are the primary pathogens implicated in a patient's clinical deterioration [3]. He developed status epilepticus, which lasted for over an hour, and aborted after administering valium suppository 5mg, IV Valium 2mg, and IV Phenytoin 400mg over 30 minutes. His parents deny any history of abnormal behavior, upper respiratory tract infection, or gastrointestinal symptoms before the beginning of symptoms. MRI brain was performed three days later, which showed bilateral symmetrical abnormal thalamic intensities, which appear hyperintense on T2 and FLAIR sequence (Figure 2). MRI brain repeated 25 days later, post-treatment showed resolution of abnormal signal intensities (Figure 3).

Discussion

Conclusions

Findings

Disclosures

Mizuguchi M